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Diarrhea - Coggle Diagram

- - - - Campylobacter jejuni
      - Salmonella
      - Aeromonas
      - Yersina enterocolítica
      - Clostridium difficile
      - Mycobacterium tuberculosis
      - Cryptosporidium
      - Cyclospora
      - Entamoeba histolytica
      - Giardia lamblia
      - Isospora belli
      - Schistosoma
      - Strongyloides
      - Trichuris
  - - - Presence of symptoms for a year or more
      - Less dan 5kg of weight loss
      - Absence of nocturnal diarrhea
      - Difficulty defecating
    - - Stool analysis
        
        Presence of occult blood
        
        Presence of leucocites
        
        Sudan stain for fat
        
        Stool culture
        
        Presence of laxatives
      - Blood tests
        
        Beta carotenes
        
        Vasoactive intestinal polypeptide and other peptide hormones
        
        Serology tests
        
        Antinuclear antibodies
        
        Anti-gliadin and anti-endomysial antibodies
        
        Perinuclear anti-neutrophil cytoplasmic antibodies
        
        HLA typing
        
        Serum immunoglobulin concentration
        
        Antibodies to HIV
        
        Antibodies to entamoeba histolytica.
      - Tests for intestinal absorption
        
        D-xilosa
        
        Schilling test
        
        Bile salts
        
        Lactose tolerance test
    - - Culture of intraluminal fluid aspirate
      - Coglycine breath test
  - - - Examination of the colon and rectal mucosa, as well as biopsy, may be useful in patients with chronic diarrhea.
    - - Some diseases that can be diagnosed with small bowel radiography are Crohn's disease, jejunal diverticulosis, carcinoid tumors, scleroderma.
    - - Celiac or mesenteric angiography may demonstrate intestinal ischemia caused by atherosclerosis or vasculitis, which is a rare cause of chronic diarrhea.
    - - CT is performed in a patient with chronic diarrhea for pancreatic evaluation (neoplasm, chronic pancreatitis) in the presence of a malabsorption syndrome or when pancreatic function results are abnormal. Inflammatory bowel disease, chronic infections such as tuberculosis, intestinal lymphoma, carcinoid syndrome, and other neuroendocrine tumors can be revealed by computed tomography.
- - - - Viral agents
        
        Rotavirus
        
        Norwalk virus
        
        Enteric adenovirus
        
        Calicivirus
        
        Astrovirus
        
        Coronavirus
        
        Herpes simplex virus
        
        Citomegalovirus
      - Parasitic agents
        
        Giardia lamblia
        
        Entamoeba histoytica
        
        Cryptosporidium
        
        Cyclospora
        
        Isospora belli
        
        Microsporida
        
        Strongyloides
      - Bacterial agents
        
        Shigella Dysenteriae
        
        Salmonella
        
        Campylobacter jejuni
        
        Escherichia coli
        
        (ET, EI, EH, OH:157)
        
        Yersinia enterocolitica
        
        Bacilus cereus
        
        Vibrio species
        
        Listeria monocytogenes
        
        Treponema pallidum
        
        Neisseria gonorrhoeae
        
        Aeromonas hydrophila
        
        Plesiomonas shigelloides
        
        Clostridium perfringens
  - - - Others alter the integrity of the mucosa through cytotoxic mediators, which may or may not invade the tissue.
      - Some have the ability to occupy tissue, which activates the host cell to initiate an energy-dependent process of endocytosis aided by the microfilament system of the intestinal mucosa (Shigella spp., enteroinvasive E. coli, rotavirus); this process leads to tissue invasion of the microorganism and destruction of the mucosa.
      - Some agents do not alter the mucosa, but lead to diarrhea secondary to the release of enterotoxins, which promote intestinal secretion (Sthaphylococcus aureus, Bacillus cereus, Clostridium botulinum).
      - The adhesion mechanism, which causes change in the structure of the villi, produces atrophy and interferes with the absorption of the luminal content (Giardia lamblia, rotavirus).
  - - - Blood test
        
        Serum electrolytes and creatinine should be requested in cases with systemic toxicity and severe dehydration, especially in the elderly and patients with comorbidities. Complete blood count is indicated in diarrhea accompanied by fever and toxicity, leukocytosis and neutrophilia indicate an inflammatory bacterial pathogen and, in some cases, provide prognostic information.
      - Stool testing
        
        Presence of blood
        
        Presence of leucocites and lactoferrin
        
        Stool culture
        
        The use of stool culture in the diagnosis of acute diarrhea is an ineffective and expensive tool
      - Rectosigmoidoscopy
        
        May be useful in the evaluation of persistent diarrhea and selected cases of acute diarrhea with colitis where the diagnosis is unclear, such as suspected toxin-negative Clostridium difficile; immunosuppressed patients due to the possibility of opportunistic agents that are difficult to diagnose, such as cytomegalovirus, especially with HIV infection.
- - - - Starting the diet early decreases intestinal permeability caused by infection, reduces the duration of symptoms, and improves nutritional outcomes. The diet should be initiated by adequate hydration with carbohydrates and electrolytes; foods high in fiber, milk, and products containing lactose should be avoided because of transient lactase deficiency secondary to infection; Caffeine consumption must be stopped, because it increases cAMP values, which promotes fluid secretion and worsens diarrhea. Avoid fats and alcohol.
    - - One of the most promising fields of study for the development of functional food components is the use of probiotics and prebiotics capable of modifying the composition and the metabolic and enzymatic activities of the intestinal microflora.
    - - Hydration is important through oral serum or prepared solutions that contain the amount of electrolytes necessary to restore the hydroelectrolyte balance. Fluids should be started at 50 to 200 mL/kg/24 h and depend on hydration status. Solutions containing electrolytes and glucose are preferred, as glucose facilitates the absorption of sodium into the intestinal lumen, and therefore water.
    - - Loperamide, bismuth, racecadotrile
    - - The drugs of choice are fluoroquinolones (ciprofloxacin 500 mg, ofloxacin 400 mg, norfloxacin 400 mg twice daily) for 3 to 7 days depending on severity. Alternative medications may be trimethoprim-sulfamethoxazole 160/800 mg twice daily, azithromycin 500 mg three times daily, metronidazole 250 mg three times daily within seven days.
        
        The etiological treatment is carried out in case a specific bacterium is identified by culture that requires antibiotic treatment in correlation with the clinical picture.